Stotland Naomi E, Haas Jennifer S, Brawarsky Phyllis, Jackson Rebecca A, Fuentes-Afflick Elena, Escobar Gabriel J
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California 94110, USA.
Obstet Gynecol. 2005 Mar;105(3):633-8. doi: 10.1097/01.AOG.0000152349.84025.35.
To study the relationships among prepregnancy body mass index (BMI), women's target gestational weight gain, and provider weight gain advice.
Project WISH, the acronym for Women and Infants Starting Healthy, is a longitudinal cohort study of pregnant women in the San Francisco Bay area. We excluded subjects with preterm birth, multiple gestation, or maternal diabetes.
Among overweight women (prepregnancy BMI 26.1-29.0), 24.1% reported a target weight gain above the Institute of Medicine (IOM) guidelines, compared with 4.3% of normal weight women (P < .001). Among women with a low prepregnancy BMI (< 19.8), 51.2% reported a target weight gain below the guidelines, compared with 10.4% of normal weight women (P < .001). These patterns persisted in a multivariate analysis. Latina ethnicity, lower maternal education, low prepregnancy BMI (< 19.8), lack of provider advice about weight gain, and provider advice to gain below guidelines were all independently associated with a target weight gain below IOM guidelines. Prepregnancy BMI more than 26, multiparity, lower age, and provider advice to gain above guidelines were all associated with a target gain above IOM guidelines.
Women's beliefs about the proper amount of weight gain and provider recommendations for weight gain vary significantly by maternal prepregnancy BMI. Many women report incorrect advice about gestational weight gain, and women with high or low prepregnancy BMI are more likely to have an incorrect target weight gain. New approaches to provider education are needed to implement the IOM guidelines for gestational weight gain.
研究孕前体重指数(BMI)、女性孕期增重目标与医护人员给出的增重建议之间的关系。
“WISH计划”(“Women and Infants Starting Healthy”的首字母缩写)是一项针对旧金山湾区孕妇的纵向队列研究。我们排除了早产、多胎妊娠或患有妊娠糖尿病的受试者。
在超重女性(孕前BMI为26.1 - 29.0)中,24.1%的人报告其孕期增重目标高于医学研究所(IOM)的指南,而正常体重女性的这一比例为4.3%(P < 0.001)。在孕前BMI较低(< 19.8)的女性中,51.2%的人报告其孕期增重目标低于指南,而正常体重女性的这一比例为10.4%(P < 0.001)。这些模式在多变量分析中依然存在。拉丁裔种族、母亲教育程度较低、孕前BMI较低(< 19.8)、缺乏医护人员关于增重的建议以及医护人员建议低于指南的增重,均与低于IOM指南的孕期增重目标独立相关。孕前BMI超过26、经产、年龄较小以及医护人员建议高于指南的增重,均与高于IOM指南的孕期增重目标相关。
女性对适当增重的看法以及医护人员对增重的建议,因母亲孕前BMI的不同而有显著差异。许多女性报告了关于孕期增重的错误建议,且孕前BMI高或低的女性更有可能有错误的孕期增重目标。需要采用新的方法对医护人员进行教育,以实施IOM的孕期增重指南。